Medicine is war: and other medical metaphors.

Abstract

When I worked in a paediatric casualty department children were forever being told that after being stitched, x rayed, or covered in plaster they would be bionic. The desire to be more like is apparently widespread?inevitably perhaps, in an age when technology is both idolised and feared. Medicine is strewn with mechanistic language and concepts, and metaphor the body is a machine suffuses much of language of pathology and physi? ology. I write here about some of linguistic forms that underlie way we talk about medicine and way that they limit as well as advance our thinking. Examining metaphors behind language is worth while because it clarifies our assumptions. Seeing body as a machine, for example, has been useful?the heart, after all, is much like a pump and treating it as one has provided many insights. The success of mechanistic approach, however, has meant that we have often imbued body with other like attributes. All too easily patients become?like machines?identical, passive and fixable. Medicine, as has often been pointed out, has become dominated by a mechanistic hubris, which sees machines and engineered solutions to ill health as favourite way forward. All this, of course, begs question of relation between language we use and things it describes. Some have felt that any language may actually prevent its native speakers from perceiving world in ways that are quite normal in other tongues.1 According to this view, language more or less determines reality. A more orthodox position is that language and our perception of world evolve together, both influencing each other. The particular vocabulary and syntax of any given language do not make it impossible to express certain things, they merely make it more difficult to express them.2 The vocabulary of medicine is certainly one example of way linguistic forms affect our perception of world. As Dixon has pointed out, we have 20 rubrics for different types of respiratory infection but only one word for poverty.3 Differentiating respiratory syncytial virus from mycoplasma thus becomes possible, but we still have only general terms with which to express, say, overcrowding. Our language thus drives important factors to margins of consciousness.